A case of no-reflow phenomenon during PCI to LIMA graft Iwatsuki-Minami hospital, Saitama, Japan Koichi Sano, Masaki Tsukagoshi, Yasunari Ueno, Seiichi Fukuda, Takayoshi Sato, Yasuyuki Maruyama
77 y.o. male Medical history This patient was hospitalized by inferior AMI 12 years ago, and was performed CABG x3 (LIMA-LAD, SVG- RCA, SVG-OM) because of his LM+multivessel disease. He was referred to our hospital for the routine check-up up. Treadmill exercise test showed positive for ischemia (Bruce 4min). Therefore, CAG was performed. CAG had been performed 1.5y ago in another hospital, and LIMA- LAD didn have a significant stenosis.
Risk factor Hypertension BP110/60, ARB, β-blocker Diabetes HbA1c 5.8%, voglibose(+) Former smoker 1pack x 40years Family history father; heart disease(?) Others Cr1.5mg/dl, UA7.1mg/dl Hyperlipidemia LDL121mg/dl, tocopherol nicotinate(+) Echocardiography Inferior wall: akinesis, LVDd/Ds 53/41, EF 45% e o a a ess, d/ s 53/, 5% Moderate MR
CAG RCA; Total occlusion
CAG LCA; Total occlusion
CAG SVG SVG-OM; Patent
CAG SVG SVG-RCA; Patent
CAG LIMA LAD; LIMA-LAD; 75% stenosis x2
CAG LIMA LAD; LIMA-LAD; 75% stenosis x2
CAG LIMA LAD; LIMA-LAD; 75% stenosis x2
CAG -summary- 12 years after CABG (LIMA-LAD, SVG-RCA, SVG-OM) He was referred to our hospital for the routine check-up, not because of facs. Both of native right and left coronary arteries were occluded. Both of 2 SVGs were patent, but LIMA-LAD had 2 stenoses. Stenoses of LIMA were located at its body, not at the anastomosis. PCI was performed 3 weeks after the CAG.
PCI LIMA-LAD; 75% stenosis x2 *PCI was performed with 6Fr guiding via his left radial artery.
PCI-LIMA Pre PCI IVUS; distal lesion Lesion length: 19mm
PCI-LIMA Pre PCI IVUS; prox lesion Lesion length: 13mm
Attenuated Iwatsuki plaque Minami at LITA Hospital PCI A Attenuated plaque was seen in prox and distal lesions. A B B C C
PCI POBA was performed without any distal protection device. The balloon was Sprinter 2.5x15mm.
PCI H21.10.28 ST elevation in V3-6 with chest pain was seen after balloon dilation. Angiogram showed no-reflow phenomenon.
PCI Nitroprusside 60 microgram was given superselectively from very distal dsta of LIMA gat graft via Crusade TM (a multifunctional probing catheter). ST level came back to the normal level, and his chest pain disappeared.
PCI Nitroprusside 60 microgram was given superselectively from very distal dsta of LIMA gat graft via Crusade TM (a multifunctional probing catheter). ST level came back to the normal level, and his chest pain disappeared.
PCI Nitroprusside 60 microgram was given superselectively from very distal dsta of LIMA gat graft via Crusade TM (a multifunctional probing catheter). ST level came back to the normal level, and his chest pain disappeared.
PCI Taxus Liberte 25 2.5x24mm24 Max14atm
PCI Taxus Liberte 275 2.75x16mm Max14atm
PCI Final angio Next day; CK188IU/l No ECG change was seen.
Summary We have experienced a case of LIMA graft stenosis with attenuated plaque by IVUS, and no-reflow phenomenon occurred during the PCI. This case has shown the usefulness of IVUS guided PCI. We should be careful when we perform PCIs to the lesions with attenuated plaque, and a distal protection device must be considered.